ASGE Postgraduate Course at ACG: Evidence-based Updates for the Practicing Gastroenterologist | October 2021-Gastric Cancer: Who and How to Screen

Video Transcription

Video Summary

In this video, Dr. Sawani Namgang Ruafang, an assistant professor of medicine at Johns Hopkins, discusses gastric cancer and its screening. Gastric cancer is one of the most common cancers worldwide and the third leading cause of cancer death. It is more prevalent in certain geographic regions like East Asia, Central and South America, and Eastern Europe. Incidents also vary among different ethnicities in the United States, with higher rates among African American, Hispanic, and Asian populations. First-generation immigrants from high-incidence countries, such as Japan and Korea, continue to have a higher risk of developing gastric cancer even after moving to the US. Gastric intestinal metaplasia (IM) and atrophic gastritis are precursor lesions for gastric cancer and are often driven by H. pylori infection. The risk of progression to gastric cancer is higher for patients with first-degree family history of gastric cancer, incomplete gastric IM, or extensive involvement of gastric IM. It is recommended to screen high-risk individuals with upper endoscopy at age 50, combining both white light and narrowband imaging (NBI) for better detection of gastric IM. Biopsy mapping is important to identify the extent and histologic subtype of gastric IM. H. pylori eradication is crucial to reduce the risk of gastric IM progression and gastric cancer incidence and mortality. For patients with dysplastic lesions or early gastric cancers, endoscopic resections, particularly endoscopic submucosal dissection (ESD), are preferred over surgery. Overall, a comprehensive and systematic approach to gastric cancer screening is necessary, particularly for high-risk populations.

Asset Subtitle

Saowanee Ngamruengphong, MD, FASGE

Keywords

gastric cancer

screening

H. pylori infection

high-risk populations

endoscopic resections